Can We Screen Febrile Children for Pneumonia and/or Bacteremia Without Chest X-ray Films and Blood Cultures?

McCarthy et al. in their article "Temperature Greater Than or Equal to 40 C in Children Less Than 24 Months of Age: A Prospective Study" (Pediatrics 59:663, May 1977) recommend using both WBC count (≥ 15,000/cu mm) and ESR (≥ 30 mm/hr) for screening febrile young children for pneumonia or bacteremia. If either is elevated they suggest doing blood cultures and taking a chest roentgenogram. However, in 25% of their patients with bacteremia and 42% of their patients with pneumonia neither WBC count nor ESR was elevated, leaving a sizable false-negative group.